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Haile TG, Benova L, Mirkuzie AH, Asefa A. Effective coverage of curative child health services in Ethiopia: analysis of the Demographic and Health Survey and Service Provision Assessment survey. BMJ Open 2024; 14:e077856. [PMID: 38382958 PMCID: PMC10882307 DOI: 10.1136/bmjopen-2023-077856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVES Despite a remarkable decline, childhood morbidity and mortality in Ethiopia remain high and inequitable. Thus, we estimated the effective coverage of curative child health services in Ethiopia. DESIGN We conducted a cross-sectional analysis of data from the 2016 Ethiopia Demographic and Health Survey (DHS) and the 2014 Ethiopia Service Provision Assessment Plus (SPA+) survey. SETTING Nationally representative household and facility surveys. PARTICIPANTS AND OUTCOMES We included a sample of 2096 children under 5 years old (from DHS) who had symptoms of one or more common childhood illnesses (diarrhoea, fever and acute respiratory infection) and estimated the percentage of sick children who were taken to a health facility (crude coverage). To construct a quality index of child health services, we used the SPA+ survey, which was conducted in 1076 health facilities and included observations of care for 1980 sick children and surveys of 1908 mothers/caregivers and 5328 health providers. We applied the Donabedian quality of care framework to identify 58 quality parameters (structure, 31; process, 16; and outcome, 11) and used the weighted additive method to estimate the overall quality of care index. Finally, we multiplied the crude coverage by the quality of care index to estimate the effective coverage of curative child health services, nationally and by region. RESULTS Among the 2096 sick children, only 38.4% (95% CI: 36.5 to 40.4) of them were taken to a health facility. The overall quality of care was 54.4%, weighted from structure (30.0%), process (9.2%) and outcome (15.2%). The effective coverage of curative child health services was estimated at 20.9% (95%CI: 19.9 to 22.0) nationally, ranging from 16.9% in Somali to 34.6% in Dire Dawa regions. CONCLUSIONS System-wide interventions are required to address both demand-side and supply-side bottlenecks in the provision of child health services if child health-related targets are to be achieved in Ethiopia.
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Affiliation(s)
- Tsegaye Gebremedhin Haile
- Department of Health Systems and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Anteneh Asefa
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Straneo M, Hanson C, van den Akker T, Afolabi BB, Asefa A, Delamou A, Dennis M, Gadama L, Mahachi N, Mlilo W, Pembe AB, Tsuala Fouogue J, Beňová L. Inequalities in use of hospitals for childbirth among rural women in sub-Saharan Africa: a comparative analysis of 18 countries using Demographic and Health Survey data. BMJ Glob Health 2024; 9:e013029. [PMID: 38262683 PMCID: PMC10806834 DOI: 10.1136/bmjgh-2023-013029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/21/2023] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION Rising facility births in sub-Saharan Africa (SSA) mask inequalities in higher-level emergency care-typically in hospitals. Limited research has addressed hospital use in women at risk of or with complications, such as high parity, linked to poverty and rurality, for whom hospital care is essential. We aimed to address this gap, by comparatively assessing hospital use in rural SSA by wealth and parity. METHODS Countries in SSA with a Demographic and Health Survey since 2015 were included. We assessed rural hospital childbirth stratifying by wealth (wealthier/poorer) and parity (nulliparity/high parity≥5), and their combination. We computed percentages, 95% CIs and percentage-point differences, by stratifier level. To compare hospital use across countries, we produced a composite index, including six utilisation and equality indicators. RESULTS This cross-sectional study included 18 countries. In all, a minority of rural women used hospitals for childbirth (2%-29%). There were disparities by wealth and parity, and poorer, high-parity women used hospitals least. The poorer/wealthier difference in utilisation among high-parity women ranged between 1.3% (Mali) and 13.2% (Rwanda). We found use and equality of hospitals in rural settings were greater in Malawi and Liberia, followed by Zimbabwe, the Gambia and Rwanda. DISCUSSION Inequalities identified across 18 countries in rural SSA indicate poor, higher-risk women of high parity had lower use of hospitals for childbirth. Specific policy attention is urgently needed for this group where disadvantage accumulates.
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Affiliation(s)
- Manuela Straneo
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Excellence for Women and Child Health, Aga Khan University, Nairobi, Kenya
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, LSHTM, London, UK
| | - Thomas van den Akker
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics & Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Bosede B Afolabi
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Anteneh Asefa
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Alexandre Delamou
- Africa Center for Excellence (CEA-PMCT), Universite Gamal Abdel Nasser de Conakry, Conakry, Guinea
- Maferinyah Training and Research Center, Forécariah, Guinea
| | | | - Luis Gadama
- Kamuzu University of Health Sciences, Blantyre, Southern Region, Malawi
| | - Nyika Mahachi
- Zimbabwe College of Public Health Physicians, Harare, Zimbabwe
| | - Welcome Mlilo
- Matabeleland North Provincial Medical Directorate, Zimbabwe Ministry of Health and Child Care, Bulawayo, Zimbabwe
| | - Andrea B Pembe
- Department of Obstetric and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jovanny Tsuala Fouogue
- Department of Obstetrics and Gynecology and Maternal Health, Faculty of Medicine and Pharmaceutical Sciences, Université de Dschang, Dschang, Cameroon
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Epidemiology and Population Health, LSHTM, London, UK
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Semaan A, Annerstedt KS, Beňová L, Dossou JP, Boyi Hounsou C, Agballa G, Namazzi G, Kandeya B, Meja S, Ally Mkoka D, Asefa A, El-halabi S, Hanson C. Provision and utilization of maternal health services during the COVID-19 pandemic in 16 hospitals in sub-Saharan Africa. Front Glob Womens Health 2023; 4:1192473. [PMID: 38025986 PMCID: PMC10644718 DOI: 10.3389/fgwh.2023.1192473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Maintaining provision and utilization of maternal healthcare services is susceptible to external influences. This study describes how maternity care was provided during the COVID-19 pandemic and assesses patterns of service utilization and perinatal health outcomes in 16 referral hospitals (four each) in Benin, Malawi, Tanzania and Uganda. Methods We used an embedded case-study design and two data sources. Responses to open-ended questions in a health-facility assessment survey were analyzed with content analysis. We described categories of adaptations and care provision modalities during the pandemic at the hospital and maternity ward levels. Aggregate monthly service statistics on antenatal care, delivery, caesarean section, maternal deaths, and stillbirths covering 24 months (2019 and 2020; pre-COVID-19 and COVID-19) were examined. Results Declines in the number of antenatal care consultations were documented in Tanzania, Malawi, and Uganda in 2020 compared to 2019. Deliveries declined in 2020 compared to 2019 in Tanzania and Uganda. Caesarean section rates decreased in Benin and increased in Tanzania in 2020 compared to 2019. Increases in maternal mortality ratio and stillbirth rate were noted in some months of 2020 in Benin and Uganda, with variability noted between hospitals. At the hospital level, teams were assigned to respond to the COVID-19 pandemic, routine meetings were cancelled, and maternal death reviews and quality improvement initiatives were interrupted. In maternity wards, staff shortages were reported during lockdowns in Uganda. Clinical guidelines and protocols were not updated formally; the number of allowed companions and visitors was reduced. Conclusion Varying approaches within and between countries demonstrate the importance of a contextualized response to the COVID-19 pandemic. Maternal care utilization and the ability to provide quality care fluctuated with lockdowns and travel bans. Women's and maternal health workers' needs should be prioritized to avoid interruptions in the continuum of care and prevent the deterioration of perinatal health outcomes.
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Affiliation(s)
- Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jean-Paul Dossou
- Department of Health Policy and Systems, Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | - Christelle Boyi Hounsou
- Department of Health Policy and Systems, Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | - Gottfried Agballa
- Department of Health Policy and Systems, Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | - Gertrude Namazzi
- Centre of Excellence for Maternal Newborn and Child Health, Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
| | - Bianca Kandeya
- College of Medicine, the Centre for Reproductive Health, University of Malawi, Blantyre, Malawi
| | - Samuel Meja
- College of Medicine, the Centre for Reproductive Health, University of Malawi, Blantyre, Malawi
| | - Dickson Ally Mkoka
- Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Anteneh Asefa
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Soha El-halabi
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
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4
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Asefa A, Gebremedhin S, Marthias T, Nababan H, Christou A, Semaan A, Banke-Thomas A, Tabana H, Al-beity FMA, Dossou JP, Gutema K, Delvaux T, Birabwa C, Dennis M, Grovogui FM, McPake B, Beňová L. Wealth-based inequality in the continuum of maternal health service utilisation in 16 sub-Saharan African countries. Int J Equity Health 2023; 22:203. [PMID: 37784140 PMCID: PMC10544383 DOI: 10.1186/s12939-023-02015-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Persistent inequalities in coverage of maternal health services in sub-Saharan Africa (SSA), a region home to two-thirds of global maternal deaths in 2017, poses a challenge for countries to achieve the Sustainable Development Goal (SDG) targets. This study assesses wealth-based inequalities in coverage of maternal continuum of care in 16 SSA countries with the objective of informing targeted policies to ensure maternal health equity in the region. METHODS We conducted a secondary analysis of Demographic and Health Survey (DHS) data from 16 SSA countries (Angola, Benin, Burundi, Cameroon, Ethiopia, Gambia, Guinea, Liberia, Malawi, Mali, Nigeria, Sierra Leone, South Africa, Tanzania, Uganda, and Zambia). A total of 133,709 women aged 15-49 years who reported a live birth in the five years preceding the survey were included. We defined and measured completion of maternal continuum of care as having had at least one antenatal care (ANC) visit, birth in a health facility, and postnatal care (PNC) by a skilled provider within two days of birth. We used concentration index analysis to measure wealth-based inequality in maternal continuum of care and conducted decomposition analysis to estimate the contributions of sociodemographic and obstetric factors to the observed inequality. RESULTS The percentage of women who had 1) at least one ANC visit was lowest in Ethiopia (62.3%) and highest in Burundi (99.2%), 2) birth in a health facility was less than 50% in Ethiopia and Nigeria, and 3) PNC within two days was less than 50% in eight countries (Angola, Burundi, Ethiopia, Gambia, Guinea, Malawi, Nigeria, and Tanzania). Completion of maternal continuum of care was highest in South Africa (81.4%) and below 50% in nine of the 16 countries (Angola, Burundi, Ethiopia, Guinea, Malawi, Mali, Nigeria, Tanzania, and Uganda), the lowest being in Ethiopia (12.5%). There was pro-rich wealth-based inequality in maternal continuum of care in all 16 countries, the lowest in South Africa and Liberia (concentration index = 0.04) and the highest in Nigeria (concentration index = 0.34). Our decomposition analysis showed that in 15 of the 16 countries, wealth index was the largest contributor to inequality in primary maternal continuum of care. In Malawi, geographical region was the largest contributor. CONCLUSIONS Addressing the coverage gap in maternal continuum of care in SSA using multidimensional and people-centred approaches remains a key strategy needed to realise the SDG3. The pro-rich wealth-based inequalities observed show that bespoke pro-poor or population-wide approaches are needed.
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Affiliation(s)
- Anteneh Asefa
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Tiara Marthias
- School of Population and Global Health, Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
- Department of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Herfina Nababan
- Institut für Public Health und Pflegeforschung, Universität Bremen, Bremen, Germany
| | - Aliki Christou
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Aduragbemi Banke-Thomas
- School of Human Sciences, University of Greenwich, London, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Hanani Tabana
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Fadhlun M. Alwy Al-beity
- Department of Obstetrcis/Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jean-Paul Dossou
- Centre de Recherche en Reproduction Humaine Et en Démographie, Cotonou, Bénin
| | - Keneni Gutema
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | - Fassou Mathias Grovogui
- Centre National de Formation Et de Recherche en Santé Rurale (CNFRSR), Maferinyah, Forécariah Guinea
| | - Barbara McPake
- School of Population and Global Health, Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Tadele H, Kassa DH, Gebriel FW, Bilal SM, Gedefaw A, Teshome M, Kawza A, Wangoro S, Muleta M, Abebo TA, Asefa A, Astatkie A, Haji Y, Alemayehu A, Aziz K, Brune T, Singhal N, Worku B, Tadesse BT. Development and evaluation of a kangaroo mother care implementation model in South Ethiopia. Acta Paediatr 2023; 112 Suppl 473:65-76. [PMID: 37519118 DOI: 10.1111/apa.16812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 04/25/2023] [Accepted: 05/02/2023] [Indexed: 08/01/2023]
Abstract
AIM To develop a model for increasing the coverage of kangaroo mother care (KMC), which involved ≥8 h of skin-to-skin contact per day and exclusive breastfeeding, for small babies with birth weight < 2000 g in South Ethiopia. METHODS A mixed methods study was conducted between June 2017 and January 2019 at four hospitals and their catchment areas. Iterative cycles of implementation, program learning and evaluation were used to optimise KMC implementation models. The study explored the community-facility continuum of care and assessed the proportion of neonates with a birth weight less than 2000 g receiving effective KMC. RESULTS Three KMC implementation models were tested with Model 2 being the final version. This model included enhanced identification of home births, improved referral linkages, immediate skin-to-skin care initiation in facilities and early contact after discharge. These improvements resulted in 86% coverage of effective facility-based KMC initiation for eligible babies. The coverage was 81.5% at discharge and 57.5% 7 days after discharge. The mean age of babies at KMC initiation was 8.2 days (SD = 5.7). CONCLUSION The study found that the KMC implementation model was feasible and can lead to substantial population-level KMC coverage for small babies.
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Affiliation(s)
- Henok Tadele
- Department of Paediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Paediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Dejene Hailu Kassa
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Fitsum W Gebriel
- Department of Paediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Selamawit Mengesha Bilal
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Abel Gedefaw
- Department of Obstetrics and Gynaecology, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Million Teshome
- Department of Obstetrics and Gynaecology, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Aknaw Kawza
- Southern Nations, Nationalities, and Peoples' Regional State Health Bureau, Hawassa, Ethiopia
| | - Shemels Wangoro
- Southern Nations, Nationalities, and Peoples' Regional State Health Bureau, Hawassa, Ethiopia
| | | | - Teshome Abuka Abebo
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Anteneh Asefa
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ayalew Astatkie
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Yusuf Haji
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Akalewold Alemayehu
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Khalid Aziz
- Department of Paediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Thomas Brune
- Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Nalini Singhal
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Bogale Worku
- Ethiopian Paediatrics Society, Addis Ababa, Ethiopia
| | - Birkneh Tilahun Tadesse
- Department of Paediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Strachan DL, Teague K, Asefa A, Annear PL, Ghaffar A, Shroff ZC, McPake B. Using health policy and systems research to influence national health policies: lessons from Mexico, Cambodia and Ghana. Health Policy Plan 2022; 38:3-14. [PMID: 36181467 PMCID: PMC9849714 DOI: 10.1093/heapol/czac083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 07/22/2022] [Accepted: 09/30/2022] [Indexed: 01/22/2023] Open
Abstract
Health system reforms across Africa, Asia and Latin America in recent decades demonstrate the value of health policy and systems research (HPSR) in moving towards the goals of universal health coverage in different circumstances and by various means. The role of evidence in policy making is widely accepted; less well understood is the influence of the concrete conditions under which HPSR is carried out within the national context and which often determine policy outcomes. We investigated the varied experiences of HPSR in Mexico, Cambodia and Ghana (each selected purposively as a strong example reflecting important lessons under varying conditions) to illustrate the ways in which HPSR is used to influence health policy. We reviewed the academic and grey literature and policy documents, constructed three country case studies and interviewed two leading experts from each of Mexico and Cambodia and three from Ghana (using semi-structured interviews, anonymized to ensure objectivity). For the design of the study, design of the semi-structured topic guide and the analysis of results, we used a modified version of the context-based analytical framework developed by Dobrow et al. (Evidence-based health policy: context and utilisation. Social Science & Medicine 2004;58:207-17). The results demonstrate that HPSR plays a varied but essential role in effective health policy making and that the use, implementation and outcomes of research and research-based evidence occurs inevitably within a national context that is characterized by political circumstances, the infrastructure and capacity for research and the longer-term experience with HPSR processes. This analysis of national experiences demonstrates that embedding HPSR in the policy process is both possible and productive under varying economic and political circumstances. Supporting research structures with social development legislation, establishing relationships based on trust between researchers and policy makers and building a strong domestic capacity for health systems research all demonstrate means by which the value of HPSR can be materialized in strengthening health systems.
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Affiliation(s)
- Daniel Llywelyn Strachan
- *Corresponding author. The Nossal Institute for Global Health, University of Melbourne, 333 Exhibition Street, Melbourne, VIC 3004, Australia. E-mail:
| | - Kirsty Teague
- The Nossal Institute for Global Health, The University of Melbourne, 333 Exhibition Street, Melbourne, VIC 3004, Australia
| | - Anteneh Asefa
- The Nossal Institute for Global Health, The University of Melbourne, 333 Exhibition Street, Melbourne, VIC 3004, Australia,Institute of Tropical Medicine, Kronenburgstraat 43, Antwerp (ITM) 2000, Belgium
| | - Peter Leslie Annear
- The Nossal Institute for Global Health, The University of Melbourne, 333 Exhibition Street, Melbourne, VIC 3004, Australia
| | - Abdul Ghaffar
- The Alliance for Health Policy and Systems Research, WHO, 20 Avenue Appia, Geneva 1211, Switzerland
| | - Zubin Cyrus Shroff
- The Alliance for Health Policy and Systems Research, WHO, 20 Avenue Appia, Geneva 1211, Switzerland
| | - Barbara McPake
- The Nossal Institute for Global Health, The University of Melbourne, 333 Exhibition Street, Melbourne, VIC 3004, Australia
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Asefa A, Dossou JP, Hanson C, Hounsou CB, Namazzi G, Meja S, Mkoka DA, Agballa G, Babirye J, Semaan A, Annerstedt KS, Delvaux T, Marchal B, Van Belle S, Pleguezuelo VC, Benova L. Methodological reflections on health system oriented assessment of maternity care in 16 hospitals in sub-Saharan Africa: an embedded case study. Health Policy Plan 2022; 37:1257-1266. [PMID: 36087095 DOI: 10.1093/heapol/czac078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/11/2022] [Accepted: 09/09/2022] [Indexed: 11/15/2022] Open
Abstract
Health Facility Assessments (HFAs) assessing facilities' readiness to provide services are well-established. However, HFA questionnaires are typically quantitative and lack depth to understand systems in which health facilities operate-crucial to designing context-oriented interventions. We report lessons from a multiple embedded case study exploring the experiences of HFA data collectors in implementing a novel HFA tool developed using systems thinking approach. We assessed 16 hospitals in four countries (Benin, Malawi, Tanzania, and Uganda) as part of a quality improvement implementation research. Our tool was organized in 17 sections and included dimensions of hospital governance, leadership, and financing; maternity care standards and procedures; ongoing quality improvement practices; interactions with communities; and mapping of the areas related to maternal care. Data for this study was collected using in-depth interviews with senior experts who conducted the HFA in the countries one to three months after completion of the HFAs. Data were analyzed using the inductive thematic analysis approach. Our HFA faced challenges in logistics (accessing key hospital-based respondents, high turnover of managerial staff, and difficulty accessing information considered sensitive in the context) and methodology (response bias, lack of data quality, and data entry into an electronic platform). Data elements of governance, leadership, and financing were the most affected. Opportunities and strategies adopted aimed at enhancing data collection (building on prior partnerships, understanding local and institutional bureaucracies) and enhancing data richness (identifying respondents with institutional memory, learning from experience, and conducting observations at various times). Moreover, HFA data collectors conducted abstraction of records and interviews in a flexible and adaptive way to enhance data quality. Lessons and new skills learned from our HFA could be used as inputs to respond to the growing need of integrating the systems thinking approach in HFA to improve contextual understanding of operations and structure.
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Affiliation(s)
- Anteneh Asefa
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jean-Paul Dossou
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Claudia Hanson
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Gertrude Namazzi
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Samuel Meja
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Dickson Ally Mkoka
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Gottfried Agballa
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Josephine Babirye
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Therese Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sara Van Belle
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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8
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Wong KL, Banke-Thomas A, Sholkamy H, Dennis ML, Pembe AB, Birabwa C, Asefa A, Delamou A, Sidze EM, Dossou JP, Waiswa P, Beňová L. Tale of 22 cities: utilisation patterns and content of maternal care in large African cities. BMJ Glob Health 2022; 7:bmjgh-2021-007803. [PMID: 35232813 PMCID: PMC8889454 DOI: 10.1136/bmjgh-2021-007803] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/27/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction Globally, the majority of births happen in urban areas. Ensuring that women and their newborns benefit from a complete package of high-quality care during pregnancy, childbirth and the postnatal period present specific challenges in large cities. We examine health service utilisation and content of care along the maternal continuum of care (CoC) in 22 large African cities. Methods We analysed data from the most recent Demographic and Health Survey (DHS) since 2013 in any African country with at least one city of ≥1 million inhabitants in 2015. Women with live births from survey clusters in the most populous city per country were identified. We analysed 17 indicators capturing utilisation, sector and level of health facilities and content of three maternal care services: antenatal care (ANC), childbirth care and postnatal care (PNC), and a composite indicator capturing completion of the maternal CoC. We developed a categorisation of cities according to performance on utilisation and content within maternal CoC. Results The study sample included 25 326 live births reported by 19 217 women. Heterogeneity in the performance in the three services was observed across cities and across the three services within cities. ANC utilisation was high (>85%); facility-based childbirth and PNC ranged widely, 77%–99% and 29%–94%, respectively. Most cities showed inconsistent levels of utilisation and content across the maternal CoC, Cotonou and Accra showed relatively best and Nairobi and Ndjamena worst performance. Conclusion This exploratory analysis showed that many DHS can be analysed on the level of large African cities to provide actionable information about the utilisation and content of the three maternal health services. Our comparative analysis of 22 cities and proposed typology of best and worst-performing cities can provide a starting point for extracting lessons learnt and addressing critical gaps in maternal health in rapidly urbanising contexts.
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Affiliation(s)
- Kerry Lm Wong
- Infectious Disease and Epidemiology, London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK
| | | | - Hania Sholkamy
- Social Research Center, American University in Cairo, Cairo, Egypt
| | | | - Andrea B Pembe
- Obstetric and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | | | - Anteneh Asefa
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Alexandre Delamou
- Department of Public Health, Universite Gamal Abdel Nasser de Conakry, Conakry, Guinea
| | | | - Jean-Paul Dossou
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium.,Public Health, Centre de recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | - Peter Waiswa
- School of Public Health, Makerere University, Kampala, Uganda
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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9
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Semaan A, Dey T, Kikula A, Asefa A, Delvaux T, Langlois EV, van den Akker T, Benova L. "Separated during the first hours"-Postnatal care for women and newborns during the COVID-19 pandemic: A mixed-methods cross-sectional study from a global online survey of maternal and newborn healthcare providers. PLOS Glob Public Health 2022; 2:e0000214. [PMID: 36962168 PMCID: PMC10022345 DOI: 10.1371/journal.pgph.0000214] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/23/2022] [Indexed: 01/22/2023]
Abstract
Routine postnatal care (PNC) allows monitoring, early detection and management of complications, and counselling to ensure immediate and long-term wellbeing of mothers and newborns; yet effective coverage is sub-optimal globally. The COVID-19 pandemic disrupted availability and quality of maternal and newborn care despite established guidelines promoting continuity of essential services. We conducted a cross-sectional global online survey of 424 maternal and newborn healthcare providers from 61 countries, to explore PNC provision, availability, content and quality following the early phase of the COVID-19 pandemic. The questionnaire (11 languages), included four multiple-choice and four open-text questions on changes to PNC during the pandemic. Quantitative and qualitative responses received between July and December 2020 were analysed separately and integrated during reporting. Tightened rules for visiting postpartum women were reported in health facilities, ranging from shorter visiting hours to banning supportive companions and visitors. A quarter (26%) of respondents reported that mothers suspected/confirmed with COVID-19 were routinely separated from their newborns. Early initiation of breastfeeding was delayed due to waiting for maternal SARS-CoV-2 test results. Reduced provision of breastfeeding support was reported by 40% of respondents in high-income countries and 7% in low-income countries. Almost 60% reported that women were discharged earlier than usual and 27% perceived a reduction in attendance to outpatient PNC. Telemedicine and home visits were mostly reported in high-income countries to ensure safe care provision. Beyond the early phase of the COVID-19 pandemic, severe disruptions to content and quality of PNC continued to exist, whereas disruptions in availability and use were less commonly reported. Depriving women of support, reducing availability of PNC services, and mother-newborn separation could lead to negative long-term outcomes for women, newborns and families, and deny their rights to respectful care. Protecting these essential services is imperative to promoting quality woman-centred PNC during and beyond the pandemic.
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Affiliation(s)
- Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Teesta Dey
- Department of Women's and Children's Health, University of Liverpool, Liverpool, United Kingdom
| | - Amani Kikula
- Muhimbili University of Health and Allied Sciences, Upanga-West, Dar es salaam, Tanzania
| | - Anteneh Asefa
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Etienne V Langlois
- Partnership for Maternal, Newborn and Child Health (PMNCH), World Health Organization (WHO), Geneva, Switzerland
| | - Thomas van den Akker
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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10
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Affiliation(s)
- Anna Galle
- Department of Public Health and Primary Care, Ghent University, Ghent 9000, Belgium.
| | - Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Anteneh Asefa
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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11
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Asefa A, McPake B, Langer A, Bohren MA, Morgan A. Imagining maternity care as a complex adaptive system: understanding health system constraints to the promotion of respectful maternity care. Sex Reprod Health Matters 2021; 28:e1854153. [PMID: 33308051 PMCID: PMC7888043 DOI: 10.1080/26410397.2020.1854153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Evidence of the health system challenges to promoting respectful maternity care (RMC) is limited in Ethiopia and globally. This study investigated the health system constraints to RMC in three Southern Ethiopian hospitals. We conducted a qualitative study (7 focus group discussions (FGDs) with providers of RMC and 12 in-depth interviews with focal persons and managers) before and after the implementation of an RMC intervention. We positioned childbirth services within the health system and applied complex adaptive system theory to analyse the opportunities and constraints to the promotion of RMC. Both system “hardware” and “software” factors influencing the promotion of RMC were identified, and their interaction was complex. The “hardware” factors included bed availability, infrastructure and supplies, financing, and health workforce. “Software” factors encompassed service providers’ mindset, staff motivation, and awareness of RMC. Interactions between these factors included privacy breaches for women when birth companions were admitted in labour rooms. Delayed reimbursement following the introduction of fee-exemption for maternity services resulted in depleted revenues, supply shortages, and ultimately disrespectful behaviour among providers. Other financial constraints, including the insufficient and delayed release of funds, also led to complex interactions with the motivation of staff and the availability of workforce and supplies, resulting in poor adherence to RMC guidance. Interventions aimed at improving only behavioural components fall short of mitigating the mistreatment of women. System-wide interventions are required to address the complex interactions that constraint RMC.
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Affiliation(s)
- Anteneh Asefa
- PhD Candidate, Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia; Assistant Professor, School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Barbara McPake
- Professor, Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Ana Langer
- Professor, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Meghan A Bohren
- Senior Lecturer, Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Alison Morgan
- Associate Professor, Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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12
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Asefa A. Unveiling respectful maternity care as a way to address global inequities in maternal health. BMJ Glob Health 2021; 6:bmjgh-2020-003559. [PMID: 33509839 PMCID: PMC7845670 DOI: 10.1136/bmjgh-2020-003559] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/26/2020] [Accepted: 01/06/2021] [Indexed: 12/15/2022] Open
Affiliation(s)
- Anteneh Asefa
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia .,Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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13
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Galle A, Semaan A, Huysmans E, Audet C, Asefa A, Delvaux T, Afolabi BB, El Ayadi AM, Benova L. A double-edged sword-telemedicine for maternal care during COVID-19: findings from a global mixed-methods study of healthcare providers. BMJ Glob Health 2021; 6:e004575. [PMID: 33632772 PMCID: PMC7908054 DOI: 10.1136/bmjgh-2020-004575] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/03/2021] [Accepted: 02/10/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has led to a rapid implementation of telemedicine for the provision of maternal and newborn healthcare. The objective of this study was to document the experiences with providing telemedicine for maternal and newborn healthcare during the pandemic among healthcare professionals globally. METHODS The second round of a global online survey of maternal and newborn health professionals was conducted, disseminated in 11 languages. Data were collected between 5 July and 10 September 2020. The questionnaire included questions regarding background, preparedness and response to COVID-19, and experiences with providing telemedicine. Descriptive statistics and qualitative thematic analysis were used to analyse responses, disaggregated by country income level. RESULTS Responses from 1060 maternal and newborn health professionals were analysed. Telemedicine was used by 58% of health professionals and two-fifths of them reported not receiving guidelines on the provision of telemedicine. Key telemedicine practices included online birth preparedness classes, antenatal and postnatal care by video/phone, a COVID-19 helpline and online psychosocial counselling. Challenges reported lack of infrastructure and technological literacy, limited monitoring, financial and language barriers, lack of non-verbal feedback and bonding, and distrust from patients. Telemedicine was considered as an important alternative to in-person consultations. However, health providers emphasised the lower quality of care and risk of increasing the already existing inequalities in access to healthcare. CONCLUSIONS Telemedicine has been applied globally to address disruptions of care provision during the COVID-19 pandemic. However, some crucial aspects of maternal and newborn healthcare seem difficult to deliver by telemedicine. More research regarding the effectiveness, efficacy and quality of telemedicine for maternal healthcare in different contexts is needed before considering long-term adaptations in provision of care away from face-to-face interactions. Clear guidelines for care provision and approaches to minimising socioeconomic and technological inequalities in access to care are urgently needed.
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Affiliation(s)
- Anna Galle
- ICRH, Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Elise Huysmans
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Constance Audet
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Anteneh Asefa
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Therese Delvaux
- Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | | | - Alison Marie El Ayadi
- Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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14
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Bilal SM, Tadele H, Abebo TA, Tadesse BT, Muleta M, W/Gebriel F, Alemayehu A, Haji Y, Kassa DH, Astatkie A, Asefa A, Teshome M, Kawza A, Wangoro S, Brune T, Singhal N, Worku B, Aziz K. Barriers for kangaroo mother care (KMC) acceptance, and practices in southern Ethiopia: a model for scaling up uptake and adherence using qualitative study. BMC Pregnancy Childbirth 2021; 21:25. [PMID: 33413193 PMCID: PMC7789316 DOI: 10.1186/s12884-020-03409-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/10/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Globally, approximately 15 million babies are born preterm every year. Complications of prematurity are the leading cause of under-five mortality. There is overwhelming evidence from low, middle, and high-income countries supporting kangaroo mother care (KMC) as an effective strategy to prevent mortality in both preterm and low birth weight (LBW) babies. However, implementation and scale-up of KMC remains a challenge, especially in lowincome countries such as Ethiopia. This formative research study, part of a broader KMC implementation project in Southern Ethiopia, aimed to identify the barriers to KMC implementation and to devise a refined model to deliver KMC across the facility to community continuum. METHODS A formative research study was conducted in Southern Ethiopia using a qualitative explorative approach that involved both health service providers and community members. Twenty-fourin-depth interviewsand 14 focus group discussions were carried out with 144study participants. The study applied a grounded theory approach to identify,examine, analyse and extract emerging themes, and subsequently develop a model for KMC implementation. RESULTS Barriers to KMC practice included gaps in KMC knowledge, attitude and practices among parents of preterm and LBW babies;socioeconomic, cultural and structural factors; thecommunity's beliefs and valueswith respect to preterm and LBW babies;health professionals' acceptance of KMC as well as their motivation to implement practices; and shortage of supplies in health facilities. CONCLUSIONS Our study suggests a comprehensive approach with systematic interventions and support at maternal, family, community, facility and health care provider levels. We propose an implementation model that addresses this community to facility continuum.
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Affiliation(s)
- Selamawit Mengesha Bilal
- College of Medicine and Health Sciences, Faculty of Health Sciences, School of Public Health, Hawassa University, Hawassa, Ethiopia.
| | - Henok Tadele
- Department of Paediatrics, College of Medicine and Health Sciences, Faculty of Medicine, Hawassa University, Hawassa, Ethiopia
- Department of Pediatrics and Child Health, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Teshome Abuka Abebo
- College of Medicine and Health Sciences, Faculty of Health Sciences, School of Public Health, Hawassa University, Hawassa, Ethiopia
| | - Birkneh Tilahun Tadesse
- Department of Paediatrics, College of Medicine and Health Sciences, Faculty of Medicine, Hawassa University, Hawassa, Ethiopia
| | | | - Fitsum W/Gebriel
- Department of Paediatrics, College of Medicine and Health Sciences, Faculty of Medicine, Hawassa University, Hawassa, Ethiopia
| | - Akalewold Alemayehu
- College of Medicine and Health Sciences, Faculty of Health Sciences, School of Public Health, Hawassa University, Hawassa, Ethiopia
| | - Yusuf Haji
- College of Medicine and Health Sciences, Faculty of Health Sciences, School of Public Health, Hawassa University, Hawassa, Ethiopia
| | - Dejene Hailu Kassa
- College of Medicine and Health Sciences, Faculty of Health Sciences, School of Public Health, Hawassa University, Hawassa, Ethiopia
| | - Ayalew Astatkie
- College of Medicine and Health Sciences, Faculty of Health Sciences, School of Public Health, Hawassa University, Hawassa, Ethiopia
| | - Anteneh Asefa
- College of Medicine and Health Sciences, Faculty of Health Sciences, School of Public Health, Hawassa University, Hawassa, Ethiopia
| | - Million Teshome
- Department of Obstetrics and Gynaecology, College of Medicine and Health Sciences, Faculty of Medicine, Hawassa University, Hawassa, Ethiopia
| | - Aknaw Kawza
- South Nations and Nationalities Regional Health Bureau Head, Hawassa, Ethiopia
| | - Shemels Wangoro
- South Nations and Nationalities Regional Health Bureau, Maternal and Child Health Director, Hawassa, Ethiopia
| | - Thomas Brune
- Sachs' Children and Youth Hospital, Stockholm, Sweden
| | | | - Bogale Worku
- School of Medicine, Addis Ababa University, Ethiopian Paediatrics Society, Addis Ababa, Ethiopia
| | - Khalid Aziz
- Paediatrics, University of Alberta, Edmonton, Canada
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15
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Asefa A, Morgan A, Gebremedhin S, Tekle E, Abebe S, Magge H, Kermode M. Mitigating the mistreatment of childbearing women: evaluation of respectful maternity care intervention in Ethiopian hospitals. BMJ Open 2020; 10:e038871. [PMID: 32883738 PMCID: PMC7473661 DOI: 10.1136/bmjopen-2020-038871] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES There is a lack of evidence on approaches to mitigating mistreatment during facility-based childbirth. This study compares the experiences of mistreatment reported by childbearing women before and after implementation of a respectful maternity care intervention. DESIGN A pre-post study design was undertaken to quantify changes in women's experiences of mistreatment during facility-based childbirth before and after the respectful maternity care intervention. INTERVENTION A respectful maternity care intervention was implemented in three hospitals in southern Ethiopia between December 2017 and September 2018 and it included training of service providers, placement of wall posters in labour rooms and post-training supportive visits for quality improvement. OUTCOME MEASURES A 25-item questionnaire asking women about mistreatment experiences was administered to 388 women (198 in the pre-intervention, 190 in the post-intervention). The outcome variable was the number of mistreatment components experienced by women, expressed as a score out of 25. Multilevel mixed-effects Poisson modelling was used to assess the change in mistreatment score from pre-intervention to post-intervention periods. RESULTS The number of mistreatment components experienced by women was reduced by 18% when the post-intervention group was compared with the pre-intervention group (adjusted regression coefficient (Aβ)=0.82, 95% CI 0.74 to 0.91). Women who had a complication during pregnancy (Aβ=1.17, 95% CI 1.01 to 1.34) and childbirth (Aβ=1.16, 95% CI 1.03 to 1.32) experienced a greater number of mistreatment components. On the other hand, women who gave birth by caesarean birth after trial of vaginal birth (Aβ=0.76, 95% CI 0.63 to 0.92) and caesarean birth without trial of vaginal birth (Aβ=0.68, 95% CI 0.47 to 0.98) experienced a lesser number of mistreatment components compared with those who had vaginal birth. CONCLUSIONS Women reported significantly fewer mistreatment experiences during childbirth following implementation of the intervention. Given the variety of factors that lead to mistreatment in health facilities, interventions designed to mitigate mistreatment need to involve structural changes.
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Affiliation(s)
- Anteneh Asefa
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alison Morgan
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Samson Gebremedhin
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ephrem Tekle
- Maternal and Child Health Directorate, Ministry of Health, Addis Ababa, Ethiopia
| | | | - Hema Magge
- Institute for Healthcare Improvement, Cambridge, Massachusetts, USA
- Division of Global Health Equity, Boston Children's Hospital, Boston, Massachusetts, USA
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Michelle Kermode
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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16
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Asefa A, Morgan A, Bohren MA, Kermode M. Lessons learned through respectful maternity care training and its implementation in Ethiopia: an interventional mixed methods study. Reprod Health 2020; 17:103. [PMID: 32615999 PMCID: PMC7331171 DOI: 10.1186/s12978-020-00953-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 06/18/2020] [Indexed: 11/12/2022] Open
Abstract
Background Improving respectful maternity care (RMC) is a recommended practice during childbirth as a strategy to eliminate the mistreatment of women and improve maternal health. There is limited evidence on the effectiveness of RMC interventions and implementation challenges, especially in low-resource settings. This study describes lessons learned in RMC training and its implementation from the perspectives of service providers’ perceptions and experiences. Methods Our mixed methods study employed a pre- and post-intervention quantitative survey of training participants to assess their perceptions of RMC and focus group discussions, two months following the intervention, investigated the experiences of implementing RMC within birthing facilities. The intervention was a three-day RMC training offered to 64 service providers from three hospitals in southern Ethiopia. We performed McNemar’s test to analyse differences in participants’ perceptions of RMC before and after the training. The qualitative data were analysed using hybrid thematic analysis. Integration of the quantitative and qualitative methods was done throughout the design, analysis and reporting of the study. Results Mistreatment of women during childbirth was widely reported by participants, including witnessing examinations without privacy (39.1%), and use of physical force (21.9%) within the previous 30 days. Additionally, 29.7% of participants reported they had mistreated a woman. The training improved the participants’ awareness of the rights of women during childbirth and their perceptions and attitudes about RMC were positively influenced. However, participants believed that the RMC training did not address providers’ rights. Structural and systemic issues were the main challenges providers reported when trying to implement RMC in their contexts. Conclusion Training alone is insufficient to improve the provision of RMC unless RMC is addressed through a lens of health systems strengthening that addresses the bottlenecks, including the rights of providers of childbirth care.
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Affiliation(s)
- Anteneh Asefa
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia. .,Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Alison Morgan
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Meghan A Bohren
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Michelle Kermode
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Australia
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17
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Asefa A, Morgan A, Hailemariam T, Shiferaw M, Mekonnen E, Birhan Y. Task shifting of emergency caesarean section in south Ethiopia: are we repeating the brain drain. Pan Afr Med J 2020; 36:145. [PMID: 32874409 PMCID: PMC7436639 DOI: 10.11604/pamj.2020.36.145.19330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 06/24/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction preventable mortality from complications which arise during pregnancy and childbirth continue to claim more than a quarter of million women´s lives every year, almost all in low- and middle-income countries. However, lifesaving emergency obstetric services, including caesarean section (CS), significantly contribute to prevention of maternal and newborn mortality and morbidity. Between 2009 and 2013, a task shifting intervention to train caesarean section (CS) teams involving 41 CS surgeons, 35 anesthetic nurses and 36 scrub nurses was implemented in 13 hospitals in southern Ethiopia. We report on the attrition rate of those upskilled to provide CS with a focus on the medium-term outcomes and the challenges encountered. Methods a cross-sectional study involving surveys of focal persons and a facility staff audit supplemented with a review of secondary data was conducted in thirteen hospitals. Mean differences were computed to appreciate the difference between numbers of CSs conducted for the six months before and after task shifting commenced. Results from the trained 112 professionals, only 52 (46.4%) were available for carrying out CS in the hospitals. CS surgeons (65.9%) and nurse anesthetists (71.4%) are more likely to have left as compared to scrub nurses (22.2%). Despite the loss of trained staff, there was an increase in the number of CSs performed after the task shifting (mean difference=43.8; 95% CI: 18.3-69.4; p=0.003). Conclusion our study, one of the first to assess the medium-term effects of task shifting highlights the risk of ongoing attrition of well-trained staff and the need to reassess strategies for staff retention.
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Affiliation(s)
- Anteneh Asefa
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.,Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Alison Morgan
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Mekonnen Shiferaw
- Southern Nations Nationalities and Peoples Regional Health Bureau, Hawassa, Ethiopia
| | - Emebet Mekonnen
- Southern Nations Nationalities and Peoples Regional Health Bureau, Hawassa, Ethiopia
| | - Yifru Birhan
- Federal Ministry of Health, Addis Ababa, Ethiopia
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18
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Medhanyie AA, Alemu H, Asefa A, Beyene SA, Gebregizabher FA, Aziz K, Bhandari N, Beyene H, Brune T, Chan G, Cranmer JN, Darmstadt G, Duguma D, Fikre A, Andualem BG, Gobezayehu AG, Mariam DH, Abay TH, Mohan HL, Jadaun A, Jayanna K, Kajal FNU, Kar A, Krishna R, Kumar A, Kumar V, Madhur TK, Belew ML, M R, Martines J, Mazumder S, Amin H, Mony PK, Muleta M, Pileggi-Castro C, Pn Rao S, Estifanos AS, Sibley LM, Singhal N, Tadele H, Tariku A, Lemango ET, Tadesse BT, Upadhyay R, Worku B, Hadush MY, Bahl R. Kangaroo Mother Care implementation research to develop models for accelerating scale-up in India and Ethiopia: study protocol for an adequacy evaluation. BMJ Open 2019; 9:e025879. [PMID: 31753865 PMCID: PMC6886988 DOI: 10.1136/bmjopen-2018-025879] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Kangaroo Mother Care (KMC) is the practice of early, continuous and prolonged skin-to-skin contact between the mother and the baby with exclusive breastfeeding. Despite clear evidence of impact in improving survival and health outcomes among low birth weight infants, KMC coverage has remained low and implementation has been limited. Consequently, only a small fraction of newborns that could benefit from KMC receive it. METHODS AND ANALYSIS This implementation research project aims to develop and evaluate district-level models for scaling up KMC in India and Ethiopia that can achieve high population coverage. The project includes formative research to identify barriers and contextual factors that affect implementation and utilisation of KMC and design scalable models to deliver KMC across the facility-community continuum. This will be followed by implementation and evaluation of these models in routine care settings, in an iterative fashion, with the aim of reaching a successful model for wider district, state and national-level scale-up. Implementation actions would happen at three levels: 'pre-KMC facility'-to maximise the number of newborns getting to a facility that provides KMC; 'KMC facility'-for initiation and maintenance of KMC; and 'post-KMC facility'-for continuation of KMC at home. Stable infants with birth weight<2000 g and born in the catchment population of the study KMC facilities would form the eligible population. The primary outcome will be coverage of KMC in the preceding 24 hours and will be measured at discharge from the KMC facility and 7 days after hospital discharge. ETHICS AND DISSEMINATION Ethics approval was obtained in all the project sites, and centrally by the Research Ethics Review Committee at the WHO. Results of the project will be submitted to a peer-reviewed journal for publication, in addition to national and global level dissemination. STUDY STATUS WHO approved protocol: V.4-12 May 2016-Protocol ID: ERC 2716. Study implementation beginning: April 2017. Study end: expected March 2019. TRIAL REGISTRATION NUMBER Community Empowerment Laboratory, Uttar Pradesh, India (ISRCTN12286667); St John's National Academy of Health Sciences, Bangalore, India and Karnataka Health Promotion Trust, Bangalore, India (CTRI/2017/07/008988); Society for Applied Studies, Delhi (NCT03098069); Oromia, Ethiopia (NCT03419416); Amhara, SNNPR and Tigray, Ethiopia (NCT03506698).
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Affiliation(s)
- Araya Abrha Medhanyie
- School of Public Health, Mekelle University College of Health Sciences, Mekelle, Ethiopia
| | - Hibret Alemu
- Urban Health, John Snow Inc, Addis Ababa, Ethiopia
| | - Anteneh Asefa
- School of Public Health, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Selemawit Asfaw Beyene
- School of Public Health, Mekelle University College of Health Sciences, Mekelle, Ethiopia
| | | | - Khalid Aziz
- Department of Neonatology, University of Alberta, Edmonton, Alberta, Canada
| | - Nita Bhandari
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Habtamu Beyene
- Southern Nations, Nationalities and Peoples' Regional Health Bureau, Hawassa, Ethiopia
| | - Thomas Brune
- Department of Neonatology, Karloniska Institute, Calgary, Alberta, Canada
| | - Grace Chan
- Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - John N Cranmer
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - G Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Dereje Duguma
- Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | - Addisalem Fikre
- Addis Ababa University, School of Public Health, Addis Ababa, Ethiopia
| | | | | | | | - Tedros Hailu Abay
- Department of Pediatrics and Child Health, Mekelle University College of Health Sciences, Mekelle, Ethiopia
| | - H L Mohan
- Community Mobilization, Karnataka Health Promotion Trust, Bangalore, India
| | - Arun Jadaun
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - K Jayanna
- Quality Improvement, Karnataka Health Promotion Trust, Bangalore, India
- Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - F N U Kajal
- National Health Mission, Indian Administrative Service, Lucknow, India
| | - Arin Kar
- Karnataka Health Promotion Trust, Bangalore, India
| | - Raghav Krishna
- Global Health, Community Empowerment Lab, Lucknow, India
| | - Aarti Kumar
- Global Health, Community Empowerment Lab, Lucknow, India
| | | | - Tarun Kumar Madhur
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | | | - Rajini M
- Department of Health and Family Welfare, Government of Karnataka, Bangalore, India
| | - Jose Martines
- Centre for Intervention Science in Maternal and Child Health, Universitetet i Bergen Senter for internasjonal helse, Bergen, Norway
| | - Sarmila Mazumder
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | | | - Prem K Mony
- Division of Epidemiology and Population Health, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India
| | | | - Cynthia Pileggi-Castro
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Suman Pn Rao
- Department of Neonatology, St John's Medical College Hospital, Bangalore, India
| | | | - Lynn M Sibley
- Global Health, Emory University School of Public Health, Atlanta, Georgia, USA
| | - Nalini Singhal
- Department of Neonatology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Henok Tadele
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | | | - Ephrem Tekle Lemango
- Maternal and Child Health Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Birkneh Tilahun Tadesse
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Ravi Upadhyay
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Bogale Worku
- Addis Ababa University, School of Public Health, Addis Ababa, Ethiopia
- Pediatrics Society, Addis Ababa, Ethiopia
| | - Marta Yemane Hadush
- Department of Pediatrics and Child Health, Mekelle University College of Health Sciences, Mekelle, Ethiopia
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
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Abstract
BACKGROUND There is dearth of data regarding the treatment-seeking practice of women living with vaginal fistula. The paper describes the health-seeking behaviour of fistula cases in the sub-Saharan Africa (SSA) where the burden of the problem is high. METHODS The data of 1,317 women who ever experienced fistula-related symptom were extracted from 16 national Demographic and Health Surveys carried out in SSA between 2010 and 2017. The association between treatment-seeking and basic socio-demographic characteristics was analysed via mixed-effects logistic regression and the outputs are provided using adjusted odds ratio (AOR) with 95% confidence intervals (CI). RESULTS Among all women who had fistula-related symptom, 67.6% encountered the problem soon after delivery, possibly implying obstetric fistula. Fewer identified sexual assault (3.8%) and pelvic surgery (2.7%) as the underlying cause. In 25.8% of the cases clear-cut causes couldn't be ascertained and, excluding these ambiguous causes, 91.2% of the women possibly had obstetric fistula. Among those who ever had any kind of fistula, 60.3% (95% CI: 56.9-63.6%) sought treatment and 28.5% (95% CI: 25.3-31.6%) underwent fistula-repair surgery. The leading reasons for not seeking treatment were: unaware that it can be repaired (21.4%), don't know where to get the treatment (17.4%), economic constraints (11.9%), the fistula healed by itself (11.9%) and feeling of embarrassment (7.9%). The regression analysis indicated, teenagers as compared to adults 35 years or older [AOR = 0.31 (95% CI: 0.20-47)]; and women without formal education compared to women with formal education [AOR = 0.69 (95% CI: 0.51-0.93)], had reduced odds of treatment-seeking. In 25.9% of the women who underwent fistula-repair surgery, complete continence after surgery was not achieved. CONCLUSION Treatment-seeking for fistula remains low and it should be improved through addressing health-system, psycho-social, economic and awareness barriers.
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Affiliation(s)
- Samson Gebremedhin
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
| | - Anteneh Asefa
- School of Public Health, Hawassa University, Hawassa, Ethiopia
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Asefa A, Gebremedhin S, Messele T, Letamo Y, Shibru E, Alano A, Morgan A, Kermode M. Mismatch between antenatal care attendance and institutional delivery in south Ethiopia: A multilevel analysis. BMJ Open 2019; 9:e024783. [PMID: 30898814 PMCID: PMC6527994 DOI: 10.1136/bmjopen-2018-024783] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Uptake of maternal health services remains suboptimal in Ethiopia. Significant proportions of antenatal care attendees give birth at home. This study was conducted to identify the predictors of non-institutional delivery among women who received antenatal care in the Southern Nations Nationalities and Peoples Region, Ethiopia. DESIGN A community-based cross-sectional survey was conducted among women who delivered in the year preceding the survey and who had at least one antenatal visit. Multistage cluster sampling was deployed to select 2390 women from all administrative zones of the region. A mixed-effects multivariable logistic regression analysis was performed to assess the predictors of non-institutional delivery; adjusted ORs (AOR) with 95% CIs are reported. RESULTS The proportion of non-institutional deliveries among participants was 62.2% (95% CI 60.2% to 64.2%). Previous experience of short and simple labour (46.9%) and uncomplicated home birth (42.9%), night-time labour (29.7%), absence of pregnancy-related problem (18.8%) and perceived providers poor reception of women (17.8%) were the main reasons to have non-institutional delivery. Attending secondary school and above (AOR=0.51; 95% CI 0.30 to 0.85), being a government employee (AOR=0.27; 95% CI 0.10 to 0.78) and woman's autonomy in healthcare utilisation decision making (AOR=0.51; 95% CI 0.33 to 0.79) were among the independent predictors negatively associated with non-institutional delivery. On the other hand, unplanned pregnancy (AOR=1.67; 95% CI 1.16 to 2.42), not experiencing any health problem during pregnancy (AOR=8.1; 95% CI 3.12 to 24.62), not perceiving the risks associated with home delivery (AOR=6.64; 95% CI 4.35 to 10.14) were the independent predictors positively associated with non-institutional delivery. CONCLUSIONS There is a missed opportunity among women attending antenatal care in southern Ethiopia. Further health system innovations that help to bridge the gap between antenatal care attendance and institutional delivery are highly recommended.
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Affiliation(s)
- Anteneh Asefa
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Samson Gebremedhin
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Tamiru Messele
- Southern Nations Nationalities and Peoples Region Health Bureau, Hawassa, Ethiopia
| | - Yohannes Letamo
- Southern Nations Nationalities and Peoples Region Health Bureau, Hawassa, Ethiopia
| | - Endashaw Shibru
- Southern Nations Nationalities and Peoples Region Health Bureau, Hawassa, Ethiopia
| | - Abraham Alano
- Southern Nations Nationalities and Peoples Region Health Bureau, Hawassa, Ethiopia
| | - Alison Morgan
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Michelle Kermode
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Abstract
OBJECTIVES Even though surgical informed consent (SIC) has marked benefits, in many settings the information is not provided appropriately. In Ethiopia, minimal attention is given to SIC. This study assesses whether an intervention designed to improve SIC in obstetric and gynaecologic surgeries is associated with receipt of SIC components. DESIGN Pre-intervention and post-intervention surveys were conducted at Hawassa University Comprehensive Specialized Hospital among women who underwent obstetric or gynaecologic surgeries. The intervention consisted of a 3-day training on standard counselling for surgical procedures offered to health professionals. A total of 457 women were surveyed (230 pre-intervention, 227 post-intervention). An adjusted Poisson regression analysis was used to identify the association between the intervention and the number of SIC components received. RESULTS The majority of participants were 25-34 years of age in both the pre-intervention and post-intervention groups (p=0.66). 45.7% of the pre-intervention and 51.5% of the post-intervention survey participants underwent elective surgery (p=0.21). Additionally, 70.4% of pre-intervention survey participants received counselling immediately before surgery, compared with 62.4% of post-intervention participants (p<0.001). 5.7% of pre-intervention and 6.6% of post-intervention participants reported the belief that SIC consists entirely of signing on a piece of paper (p=0.66). After controlling for effects of potential confounders, the number of SIC components reported by post-intervention survey participants was 16% higher than what is received by pre-intervention ones (adjusted coefficient=1.16 (1.06-1.28)). Having elective versus emergency surgery was not associated with the number of components received by participants in either group (adjusted coefficient=0.98 (0.88-1.09)). CONCLUSION Training on the delivery of standard SIC is associated with receipt of a higher number of standard counselling components. However, there is a need to evaluate whether a one-time intervention leads to sustained improvement. A system-wide study of factors that promote SIC is required.
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Affiliation(s)
- Million Teshome
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Zenebe Wolde
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Abel Gedefaw
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Anteneh Asefa
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Gebremedhin S, Asefa A. Association between type of contraceptive use and haemoglobin status among women of reproductive age in 24 sub-Saharan Africa countries. BMJ Sex Reprod Health 2018; 45:bmjsrh-2018-200178. [PMID: 30463847 DOI: 10.1136/bmjsrh-2018-200178] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/10/2018] [Accepted: 10/31/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Little is known whether contraceptive methods differentially modify women's risk of anaemia or not. We compared the haemoglobin status of women currently using different fertility regulation methods in sub-Saharan Africa (SSA) where anaemia is a major concern. METHODS We conducted the study based on the secondary data of 24 nationally representative demographic and health surveys carried out recently in SSA. The data of 105 532 women were included in the analysis. In the original surveys, respondents were selected using multistage sampling techniques and haemoglobin was determined using the HemoCue analyser. The association between method of contraception and anaemia status was determined via a mixed-effects logistic regression model adjusted for potential confounders. The outputs are presented using adjusted odds ratio (AOR) with 95% CI. RESULTS The mean (±SD deviation) haemoglobin was 12.3 (±1.7) g/dl and 36.7% of the women had anaemia. Current use of modern contraceptives, as compared with non-use, was associated with a 25% reduction (AOR=0.75 (95% CI: 0.73 to 0.78)) in the odds of anaemia. Comparison among individual modern methods showed, as compared with current barrier methods users, use of injectables (AOR=0.62 (95% CI: 0.57 to 0.67)), oral contraceptive pills (OCP) (AOR=0.62 (95% CI: 0.57 to 0.66)) and implants (AOR=0.63 (95% CI: 0.58 to 0.70)) were significantly associated with reduced odds of anaemia. With reference to women with less than 12 months of use, the odds were significantly reduced by about a quarter among women with more than 12 months of OCP or injectables use. CONCLUSION The use of hormonal contraceptives is associated with lower odds of anaemia.
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Affiliation(s)
| | - Anteneh Asefa
- School of Public Health, Hawassa University, Hawassa, Ethiopia
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Teshome M, Wolde Z, Gedefaw A, Tariku M, Asefa A. Surgical informed consent in obstetric and gynecologic surgeries: experience from a comprehensive teaching hospital in Southern Ethiopia. BMC Med Ethics 2018; 19:38. [PMID: 29793471 PMCID: PMC5968605 DOI: 10.1186/s12910-018-0293-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/17/2018] [Indexed: 11/12/2022] Open
Abstract
Background Surgical Informed Consent (SIC) has long been recognized as an important component of modern medicine. The ultimate goals of SIC are to improve clients’ understanding of the intended procedure, increase client satisfaction, maintain trust between clients and health providers, and ultimately minimize litigation issues related to surgical procedures. The purpose of the current study is to assess the comprehensiveness of the SIC process for women undergoing obstetric and gynecologic surgeries. Methods A hospital-based cross-sectional study was undertaken at Hawassa University Comprehensive Specialized Hospital (HUCSH) in November and December, 2016. A total of 230 women who underwent obstetric and/or gynecologic surgeries were interviewed immediately after their hospital discharge to assess their experience of the SIC process. Thirteen components of SIC were used based on international recommendations, including the Royal College of Surgeon’s standards of informed consent practices for surgical procedures. Descriptive summaries are presented in tables and figures. Results Forty percent of respondents were aged between 25 and 29 years. Nearly a quarter (22.6%) had no formal education. More than half (54.3%) of respondents had undergone an emergency surgical procedure. Only 18.4% of respondents reported that the surgeon performing the operation had offered SIC, while 36.6% of respondents could not recall who had offered SIC. All except one respondent provided written consent to undergo a surgical procedure. However, 8.3% of respondents received SIC service while already on the operation table for their procedure. Only 73.9% of respondents were informed about the availability (or lack thereof) of alternative treatment options. Additionally, a majority of respondents were not informed about the type of anesthesia to be used (88.3%) and related complications (87.4%). Only 54.2% of respondents reported that they had been offered at least six of the 13 SIC components used by the investigators. Conclusions There is gap in the provision of comprehensive and standardized pre-operative counseling for obstetric and gynecologic surgeries in the study hospital. This has a detrimental effect on the overall quality of care clients receive, specifically in terms of client expectations and information needs. Electronic supplementary material The online version of this article (10.1186/s12910-018-0293-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Million Teshome
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine and Health Sciences, Hawassa University, P.O.Box 1560, Hawassa, Ethiopia.
| | - Zenebe Wolde
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine and Health Sciences, Hawassa University, P.O.Box 1560, Hawassa, Ethiopia
| | - Abel Gedefaw
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine and Health Sciences, Hawassa University, P.O.Box 1560, Hawassa, Ethiopia
| | - Mequanent Tariku
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine and Health Sciences, Hawassa University, P.O.Box 1560, Hawassa, Ethiopia
| | - Anteneh Asefa
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, P.O.Box 70, Hawassa, Ethiopia.,Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Level 5, 333 Exhibition Street, Melbourne, 3000, Australia
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Chea N, Asefa A. Prelacteal feeding and associated factors among newborns in rural Sidama, south Ethiopia: a community based cross-sectional survey. Int Breastfeed J 2018; 13:7. [PMID: 29467812 PMCID: PMC5819158 DOI: 10.1186/s13006-018-0149-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 02/02/2018] [Indexed: 11/18/2022] Open
Abstract
Background The practice of giving prelacteal feeds deprive a newborn of valuable nutrients and expose the newborn to risks of infection. Despite its negative health outcomes, prelacteal feeding prevails in Ethiopia. Therefore, the current study was undertaken to assess the prevalence of prelacteal feeding practices and its associated factors in a rural community in south Ethiopia. Methods We conducted a community based cross-sectional study of 597 mothers of children aged less than six months. Mothers were selected using a multistage cluster sampling technique from Hawela Tula, a rural catchment under Hawassa City Administration. Newborns exposed to any foods, substances or drinks other than human milk before the initiation of breastfeeding or during the first three days of birth were regarded as receiving prelacteal feeds. Descriptive summaries were done to present the main findings; bivariate and multivariate logistic regression analyses were undertaken to identify variables associated with prelacteal feeding practices. Results Among the total infants, 25.5% (95% confidence interval [CI] 23.5%, 27.5%) were found to be exposed to prelacteal feeds. Boiled water (36.8%) and fresh butter (32.2%) were the top two prelacteal foods. The prevalence of prelacteal feeding was higher among infants whose mothers are housewives, and among infants born to mothers aged between 21 and 34 years. Almost two-third (64.3%) of mothers who exposed their newborn to prelacteal feeds did so with advice from their parents. Mothers who had poor knowledge on breastfeeding were nine times more likely to practice prelacteal feeding compared to those with good knowledge (adjusted odds ratio [AOR] 8.9, 95% CI 4.2, 18.7). Lack of knowledge on the risks associated with prelacteal feeding (AOR 6.8; 95% CI 2.6, 17.8) and misconceptions about breastfeeding (AOR 8.1; 95% CI 3.9, 16.6) were associated with prelacteal feeding. However, mothers’ place of delivery and attendance at breastfeeding counseling sessions showed no association with the practice of prelacteal feeding. Conclusions Prelacteal feeding is commonly practiced in the study area. Raising women’s awareness on the consequences of prelacteal feeding is warranted. Involving parents of women when promoting optimal infant feeding practices should be emphasized.
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Affiliation(s)
- Nana Chea
- 1School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Anteneh Asefa
- 1School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.,2Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
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Asefa A, Bekele D, Morgan A, Kermode M. Service providers' experiences of disrespectful and abusive behavior towards women during facility based childbirth in Addis Ababa, Ethiopia. Reprod Health 2018; 15:4. [PMID: 29304814 PMCID: PMC5756390 DOI: 10.1186/s12978-017-0449-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 12/26/2017] [Indexed: 11/10/2022] Open
Abstract
Background Disrespect and abuse (D&A) of women during childbirth by the attending staff in health facilities has been widely reported in many countries. Although D&A in labor rooms is recognized as a deterrent to maternal health service utilization, approaches to defining, classifying, and measuring D&A are still at an early stage of development. This study aims to enhance understanding of service providers’ experiences of D&A during facility based childbirth in health facilities in Addis Ababa. Methods A facility based cross-sectional study was conducted in August 2013 in one hospital and three health centers. A total of 57 health professionals who had assisted with childbirth during the study period completed a self-administered questionnaire. Service providers’ personal observations of mistreatment during childbirth and their perceptions of respectful maternity care (RMC) were assessed. Data were entered into and analyzed using SPSS version 16 software. Results The majority (83.7%) of participants were aged <30 years (mean = 27.25 ± 5.45). Almost half (43.9%) were midwives, and 77.2% had less than five years experience as a health professional. Work load was reported to be very high by 31.6% of participants, and 28% rated their working environment as poor or very poor. Almost half (50.3%) of participants reported that service providers do not generally obtain women’s consent prior to procedures. One-quarter (25.9%) reported having ever witnessed physical abuse (physical force, slapping, or hitting) in their health facility. They also reported observing privacy violations (34.5%), and women being detained against their will (18%). Violations of women’s rights were self-reported by 14.5% of participants. More than half (57.1%) felt that they had been disrespected and abused in their work place. The majority of participants (79.6%) believed that lack of respectful care discourages pregnant women from coming to health facilities for delivery. Conclusions The study findings indicate that most service providers from these facilities had witnessed disrespectful practices during childbirth, and recognized that such practices have negative consequences for service utilization. These findings can help decision makers plan for interventions to improve RMC taking account of the provider perspective.
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Affiliation(s)
- Anteneh Asefa
- School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, P.O.Box 70, Hawassa, Ethiopia. .,Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Level 5, 333 Exhibition Street, Melbourne, 3000, Australia.
| | - Delayehu Bekele
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, P.O.Box 143079, Addis Ababa, Ethiopia
| | - Alison Morgan
- Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Level 5, 333 Exhibition Street, Melbourne, 3000, Australia
| | - Michelle Kermode
- Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Level 5, 333 Exhibition Street, Melbourne, 3000, Australia
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Sando D, Abuya T, Asefa A, Banks KP, Freedman LP, Kujawski S, Markovitz A, Ndwiga C, Ramsey K, Ratcliffe H, Ugwu EO, Warren CE, Jolivet RR. Methods used in prevalence studies of disrespect and abuse during facility based childbirth: lessons learned. Reprod Health 2017; 14:127. [PMID: 29020966 PMCID: PMC5637332 DOI: 10.1186/s12978-017-0389-z] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/25/2017] [Indexed: 11/10/2022] Open
Abstract
Background Several recent studies have attempted to measure the prevalence of disrespect and abuse (D&A) of women during childbirth in health facilities. Variations in reported prevalence may be associated with differences in study instruments and data collection methods. This systematic review and comparative analysis of methods aims to aggregate and present lessons learned from published studies that quantified the prevalence of Disrespect and Abuse (D&A) during childbirth. Methods We conducted a systematic review of the literature in accordance with PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Five papers met criteria and were included for analysis. We developed an analytical framework depicting the basic elements of epidemiological methodology in prevalence studies and a table of common types of systematic error associated with each of them. We performed a head-to-head comparison of study methods for all five papers. Using these tools, an independent reviewer provided an analysis of the potential for systematic error in the reported prevalence estimates. Results Sampling techniques, eligibility criteria, categories of D&A selected for study, operational definitions of D&A, summary measures of D&A, and the mode, timing, and setting of data collection all varied in the five studies included in the review. These variations present opportunities for the introduction of biases – in particular selection, courtesy, and recall bias – and challenge the ability to draw comparisons across the studies’ results. Conclusion Our review underscores the need for caution in interpreting or comparing previously reported prevalence estimates of D&A during facility-based childbirth. The lack of standardized definitions, instruments, and study methods used to date in studies designed to quantify D&A in childbirth facilities introduced the potential for systematic error in reported prevalence estimates, and affected their generalizability and comparability. Chief among the lessons to emerge from comparing methods for measuring the prevalence of D&A is recognition of the tension between seeking prevalence measures that are reliable and generalizable, and attempting to avoid loss of validity in the context where the issue is being studied. Electronic supplementary material The online version of this article (10.1186/s12978-017-0389-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David Sando
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Timothy Abuya
- Population Council, Reproductive Health Program, 5 Rose Avenue, PO Box 17643-00500, Nairobi, Kenya
| | - Anteneh Asefa
- School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia
| | - Kathleen P Banks
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Ave, Crosstown Building, 3rd Floor, Boston, MA, 02118, USA
| | - Lynn P Freedman
- Averting Maternal Death and Disability Program (AMDD), Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, 60 Haven Avenue, B3, New York, NY, 10032, USA
| | - Stephanie Kujawski
- Department of Epidemiology, Columbia University Mailman School of Public Health, 60 Haven Avenue, B3, New York, NY, 10032, USA
| | - Amanda Markovitz
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115; 677 Huntington Ave, Boston, MA, 02115, USA
| | - Charity Ndwiga
- Population Council, Ralph Bunche Rd, Nairobi City, Nairobi, Kenya
| | - Kate Ramsey
- Management Sciences for Health, 45 Broadway #320, New York, NY, 10006, USA
| | - Hannah Ratcliffe
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, 401 Park Drive, Boston, MA, 02215, USA
| | - Emmanuel O Ugwu
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, College of Medicine, University of Nigeria Enugu Campus, Enugu, Enugu State, Nigeria
| | - Charlotte E Warren
- Population Council, 4301 Connecticut Ave NW # 280, Washington, DC, 20008, USA
| | - R Rima Jolivet
- Maternal Health Task Force, Women & Health Initiative, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 651 Huntington Avenue, Boston, MA, 02115, USA.
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Teshome W, Asefa A. Correction: Predictors of Immunological Failure of Antiretroviral Therapy among HIV Infected Patients in Ethiopia: A Matched Case-Control Study. PLoS One 2015; 10:e0128393. [PMID: 25962133 PMCID: PMC4427101 DOI: 10.1371/journal.pone.0128393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Asefa A, Bekele D. Status of respectful and non-abusive care during facility-based childbirth in a hospital and health centers in Addis Ababa, Ethiopia. Reprod Health 2015; 12:33. [PMID: 25890317 PMCID: PMC4403719 DOI: 10.1186/s12978-015-0024-9] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 04/02/2015] [Indexed: 11/12/2022] Open
Abstract
Background According to the 2011 Ethiopian Demographic and Health Survey, 90.1% of mothers do not deliver in health facilities, with 29.5% citing non-customary service as causative. A low level of skilled attendance at birth is among the leading causes of maternal mortality in low - and middle-income countries. Methods A cross-sectional study was undertaken in four health facilities (one specialized teaching hospital and its three catchment health centers) in Addis Ababa, Ethiopia, to quantitatively determine the level and types of disrespect and abuse faced by women during facility-based childbirth, along with their subjective experiences of disrespect and abuse. A questionnaire was administered to 173 mothers immediately prior to discharge from their respective health facility. Reported disrespect and abuse during childbirth was measured under seven categories using 23 performance indicators. Results Among multigravida mothers (n = 103), 71.8% had a history of a previous institutional birth and 78% (75.3% in health centers and 81.8% in hospital; p = 0.295) of respondents experienced one or more categories of disrespect and abuse. The violation of the right to information, informed consent, and choice/preference of position during childbirth was reported by all women who gave birth in the hospital and 89.4% of respondents in health centers. Mothers were left without attention during labor in 39.3% of cases (14.1% in health centers and 63.6% in hospital; p < 0.001). Although 78.6% (n = 136) of respondents objectively faced disrespect and abuse, only 22 (16.2%) subjectively experienced disrespect and abuse. Conclusions This quantitative study reveals a high level of disrespect and abuse during childbirth that was not perceived as such by the majority of respondents. It is every woman’s right to give birth in woman-centered environment free from disrespect and abuse. Understanding how women define abuse is crucial if Ethiopia is to succeed in increasing the uptake of facility-based births.
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Affiliation(s)
- Anteneh Asefa
- School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia.
| | - Delayehu Bekele
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
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Gedefaw A, Tilahun B, Asefa A. Predictors of self-reported academic performance among undergraduate medical students of Hawassa University, Ethiopia. Adv Med Educ Pract 2015; 6:305-315. [PMID: 25914564 PMCID: PMC4399784 DOI: 10.2147/amep.s78604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND This study was conducted to identify predictors of self-reported academic performance in undergraduate medical students at Hawassa University. METHODS An analytical cross-sectional study involving 592 undergraduate medical students was conducted in November 2012. The academic performance of the study subjects was measured by self-reported cumulative grade point average (GPA) using a self-administered questionnaire. Data were entered and analyzed using Statistical Package for the Social Sciences version 16 software. Pearson's bivariate correlations, multiple linear regression, and multiple logistic regression were used to identify predictors of academic performance. RESULTS The self-reported academic performance of students had been decreasing as the academic years progressed, with the highest and lowest performance being in the premedicine (mean GPA 3.47) and clinical I (mean GPA 2.71) years, respectively. One hundred and fifty-eight (26.7%) of the participants had ever been delayed, 37 (6.2%) had ever re-sat for examination, and two (0.3%) had ever been warned due to academic failure. The overall variation in self-reported academic performance of the students was 32.8%. Participant age alone explained 21.9% of the variation. On the other hand, university entrance examination results, substance use at university, and medicine as first choice by students were identified as predictors of variation in self-reported academic performance, accounting for 6.9%, 2.7%, and <1% of the variation, respectively. Students who had never used tobacco, alcohol, or khat after starting university were twice as likely to score a self-reported cumulative GPA above 3.0 (adjusted odds ratio 1.95, 95% confidence interval 1.25-3.02) and less likely to be delayed, have to re-sit an examination, or be warned (adjusted odds ratio 0.47, 95% confidence interval 0.29-0.77). CONCLUSION Only 32.8% of the variation in self-reported academic performance was explained by the studied variables. Hence, efficacious mechanisms should be designed to combat the intervenable determinants of self-reported academic performance, like substance use and a low medical school entrance examination result. Further studies should also be undertaken to gain a better understanding of other unstudied determinants, like personality, learning style, cognitive ability, and the system used for academic evaluation.
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Affiliation(s)
- Abel Gedefaw
- Department of Gynecology and Obstetrics, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Birkneh Tilahun
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Anteneh Asefa
- School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Deressa W, Seme A, Asefa A, Teshome G, Enqusellassie F. Utilization of PMTCT services and associated factors among pregnant women attending antenatal clinics in Addis Ababa, Ethiopia. BMC Pregnancy Childbirth 2014; 14:328. [PMID: 25234199 PMCID: PMC4175621 DOI: 10.1186/1471-2393-14-328] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 09/18/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) remains the major source of HIV infection in young children. Targeting pregnant women attending antenatal clinics provide a unique opportunity for implementing prevention of mother-to-child transmission (PMTCT) programmes against HIV infection of newborn babies. This study aimed to investigate factors associated with the acceptability and utilization of PMTCT of HIV. METHODS An institution based cross-sectional study was conducted in April 2010 using exit interviews with 843 pregnant women attending antenatal care (ANC) clinics of 10 health centers and two hospitals in Addis Ababa, Ethiopia. Trained nurses administered structured questionnaires to collect data on socio-demographic characteristics, knowledge about MTCT, practice of HIV testing and satisfaction with the antenatal care services. Six focus group discussions among pregnant women and 22 in-depth interviews with service providers complemented the quantitative data. RESULTS About 94% of the pregnant women visited the health facility for ANC check-up. Only 18% and 9% of respondents attended the facility for HIV counselling and testing (HCT) and receiving antiretroviral prophylaxis, respectively. About 90% knew that a mother with HIV can pass the virus to her child, and MTCT through breast milk was commonly cited by most women (72.4%) than transmission during pregnancy (49.7%) or delivery (49.5%). About 94% of them reported that they were tested for HIV in the current pregnancy and 60% replied that their partners were also tested for HIV. About 80% of the respondents reported adequacy of privacy and confidentiality during counseling (90.8% at hospitals and 78.6% at health centers), but 16% wished to have a different counselor. Absence of counselors, poor counselling, lack of awareness and knowledge about HCT, lack of interest and psychological unpreparedness were the main reasons cited for not undergoing HIV testing during the current pregnancy. CONCLUSIONS HIV testing among ANC attendees and knowledge about MTCT of HIV was quite high. Efforts should be made to improve the quality and coverage of HCT services and mitigate the barriers preventing mothers from seeking HIV testing. Further research should be conducted to evaluate the uptake of antiretroviral prophylaxis among HIV-positive pregnant women attending ANC clinics.
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Affiliation(s)
- Wakgari Deressa
- />School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Assefa Seme
- />School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Anteneh Asefa
- />College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Getachew Teshome
- />Addis Ababa City Administration Health Bureau, Addis Ababa, Ethiopia
| | - Fikre Enqusellassie
- />School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Asefa A, Teshome W. Total delay in treatment among smear positive pulmonary tuberculosis patients in five primary health centers, southern Ethiopia: a cross sectional study. PLoS One 2014; 9:e102884. [PMID: 25048601 PMCID: PMC4105549 DOI: 10.1371/journal.pone.0102884] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 06/20/2014] [Indexed: 11/23/2022] Open
Abstract
Introduction The global burden of Tuberculosis (TB) remains enormous. Delay in TB diagnosis may lead to a higher infectious pool in the community and a more advanced disease state at presentation increasing the risk of mortality. This study is conducted to determine the total delay before treatment among smear positive Pulmonary Tuberculosis (PTB) patients. Methods A health institution based cross sectional study was conducted in five primary health centers in southern Ethiopia from June to December 2012. A total of 328 smear positive PTB patients were enrolled in the study. A structured and pre-tested questionnaire was used. Median patient, diagnostic, and treatment delays were calculated to determine the total delay. Multiple logistic regression analysis was used to identify factors associated with total delay. Results The median patient, diagnostic, treatment and total delays measured in days were 30 (IQR 20.2, 60), 7 (IQR: 3, 14), 3 (IQR: 1, 4) and 45 (IQR: 34.5, 69.5) days respectively. Patients for whom treatment was not initiated within 45 days of onset of symptom(s) (total delay) constituted 49% of the study participants (59.5% among males and 39.2% among females; P<0.001). Total delay was found to be associated with: being female [AOR = 0.34, 95% CI: 0.18–0.62], having attended tertiary level education [AOR = 0.11, 95% CI: 0.02–0.55], perceived severity of stigma during the current TB disease course [AOR = 2. 18, 95% CI: 1.07, 4.42] and living in houses with higher family size [AOR = 0.26, 95% CI: 0.11, 0.61]. Conclusion Total delay in treatment of TB is still high in the study area. Patient's sex, perceived stigma, educational status and family size are significantly contributing for total delay. Therefore, a concerted effort should be taken in order to improve health seeking behavior of the community on TB and to reduce delays from seeking care after experiencing TB symptoms.
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Affiliation(s)
- Anteneh Asefa
- School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- * E-mail:
| | - Wondu Teshome
- School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Asefa A, Mitike G. Prevention of mother-to-child transmission (PMTCT) of HIV services in Adama town, Ethiopia: clients' satisfaction and challenges experienced by service providers. BMC Pregnancy Childbirth 2014; 14:57. [PMID: 24484774 PMCID: PMC3912258 DOI: 10.1186/1471-2393-14-57] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 01/28/2014] [Indexed: 11/10/2022] Open
Abstract
Background The coverage and uptake of prevention of mother-to-child transmission (PMTCT) of HIV services has remained very low in Ethiopia. One of the pillars of improving quality of health services is measuring and addressing client satisfaction. In Ethiopia, information about the quality of PMTCT services regarding client satisfaction is meager. Methods A facility-based cross-sectional study using quantitative methods was conducted in Adama town. We interviewed 423 pregnant women and 31 health providers from eight health facilities. Satisfaction of clients was measured using a standard questionnaire adapted from the UNAIDS best practices collection on HIV/AIDS. Bivariate and multivariate logistic regression analyses were used to identify factors associated with clients’ satisfaction. Results About three-fourth (74.7%) of clients reported that they were satisfied with the PMTCT services provided by the health facilities. However, a much lower proportion (39%) of the total respondents (pregnant women who underwent an ANC follow-up session), said they received and understood the messages related to mother-to-child transmission (MTCT) of HIV and PMTCT. The main challenges reported by service providers were lack of training, lack of feedback on job performance and inadequate pay. Clients’ satisfaction with PMTCT service was found to be associated with liking the discussion they had with their counselor, non-preference to a different counselor with regards to sex and/or age and not seeing the same ANC counselor before and after HIV test. Conclusion Although 74.7% of clients were satisfied, the majority did not have a good understanding of the counseling on MTCT and PMTCT. We recommend more efforts to be exerted on improving provider-client communication, devising ways of increasing clients’ satisfaction and designing an effective motivation strategy for service providers to enhance the status of PMTCT services.
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Affiliation(s)
- Anteneh Asefa
- School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia.
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Asefa A, Beyene H. Awareness and knowledge on timing of mother-to-child transmission of HIV among antenatal care attending women in Southern Ethiopia: a cross sectional study. Reprod Health 2013; 10:66. [PMID: 24330487 PMCID: PMC3866506 DOI: 10.1186/1742-4755-10-66] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 12/10/2013] [Indexed: 11/10/2022] Open
Abstract
Background Mother-to-child transmission (MTCT) of HIV infection remains a major public health problem and constitutes the most important cause of HIV infection in children under the age of 15 years old. Awareness on MTCT of HIV and knowledge of its timing usually pose a direct effect on utilization of PMTCT services (mainly HIV testing, infant feeding options and antiretroviral use). The objective of this study is to assess pregnant women’s knowledge on timing of MTCT of HIV in Southern Ethiopia. Methods A cross sectional study was conducted in 62 health centers in Southern Ethiopia from February 25 to March 24, 2012. A total of 1325 antenatal care attending women were included in the survey by using a multistage sampling technique. Data were collected using a structured and pre-tested questionnaire. Multiple logistic regression analysis was employed to identify variables associated with women’s knowledge on timing of MTCT of HIV. Results All interviewed pregnant women were aware of HIV/AIDS transmission, but only 60.7% were aware of the risk of MTCT. The possibility of MTCT during pregnancy, delivery and breastfeeding was known by 48.4%, 58.6% and 40.7% of the respondents, respectively. The proportion of women who were fully knowledgeable on timing of MTCT was 11.5%. Women’s full knowledge on timing of MTCT was associated with maternal education [AOR = 3.68, 95% CI: 1.49-9.08], and being government employee [AOR = 2.50, 95% CI: 1.23- 5.07]. Whereas, there was a negative association between full knowledge of women on timing of MTCT and no offer of information on MTCT/PMTCT by antenatal care (ANC) service provider [AOR = 0.44, 95% CI: 0.30-0.64], lack of discussion on ANC with male partner [AOR = 0.30, 95% CI: 0.12-0.72], and lack of discussion on HIV/AIDS with male partner [AOR = 0.17, 95% CI: 0.07-0.43]. Conclusion There was low awareness and knowledge on timing of MTCT of HIV in this study. Hence, strengthening the level of PMTCT services in ANC settings and devising mechanisms to promote involvement of men in PMTCT services is needed.
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Affiliation(s)
- Anteneh Asefa
- School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia.
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Sissay MM, Asefa A, Uggla A, Waller PJ. Assessment of anthelmintic resistance in nematode parasites of sheep and goats owned by smallholder farmers in eastern Ethiopia. Trop Anim Health Prod 2006; 38:215-22. [PMID: 16986769 DOI: 10.1007/s11250-006-4346-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The anthelmintic resistance status was investigated of nematode parasites of sheep and goats owned by smallholder farmers in communities that received breeding stock from a source where a high level of anthelmintic resistance has been reported. The investigation used the faecal egg count reduction technique, whereby suitable animals within each of eight separate communities were pooled to achieve the numbers required to conduct separate tests for both sheep and goats. Anthelmintics tested were albendazole (ABZ), tetramisole (TET), a combination (ABZ + TET) and ivermectin (IVM), at the manufacturers' recommended dose rates. Results showed that there was no evidence of anthelmintic resistance in nematode parasites of either sheep an goats in any community. This indicates that dilution of resistant parasites imported with introduced breeding stock, and the low selection pressure imposed by the smallholder farmers themselves, has prevented anthelmintic resistance from emerging in nematode parasites of small ruminants in these communities.
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Affiliation(s)
- M M Sissay
- Department of Parasitology (SWEPAR), National Veterinary Institute and Swedish University of Agricultural Sciences, Uppsala, Sweden
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